Abstract
BackgroundInadvertent perioperative hypothermia (< 36 °C) occurs frequently during elective cesarean delivery and most institutions do employ perioperative active warming. The purpose of this retrospective observational cohort study was to determine if the addition of preoperative forced air warming in conjunction with intraoperative underbody forced air warming improved core temperature and reducing inadvertent perioperative hypothermia during elective repeat elective cesarean delivery with neuraxial anesthesia.MethodsWe evaluated the addition of perioperative active warming to standard passive warming methods (preheated intravenous/irrigation fluids and cotton blankets) in 120 parturients scheduled for repeat elective cesarean delivery (passive warming, n = 60 vs. active + passive warming, n = 60) in a retrospective observational cohort study. The primary outcomes of interest were core temperature at the end of the procedure and a decrease in inadvertent perioperative hypothermia (< 36 °C). Secondary outcomes were surgical site infections and adverse markers of neonatal outcome.ResultsThe mean temperature at the end of surgery after instituting the active warming protocol was 36.0 ± 0.5 °C (mean ± SD, 95% CI 35.9–36.1) vs. 35.4 ± 0.5 °C (mean ± SD, 95% CI 35.3–35.5) compared to passive warming techniques (p < 0.001) and the incidence of inadvertent perioperative hypothermia at the end of the procedure was less in the active warming group - 68% versus 92% in the control group (p < 0.001). There was no difference in surgical site infections or neonatal outcomes.ConclusionsPerioperative active warming in combination with passive warming techniques was associated with a higher maternal temperature and lower incidence of inadvertent perioperative hypothermia with no detectable differences in surgical site infections or indicators of adverse neonatal outcomes.
Highlights
Inadvertent perioperative hypothermia in the general surgical population is associated with complications ranging from bleeding and cardiac dysfunction to increased infections [1,2,3]
Our primary objectives were to determine if standardized implementation of pre- and intraoperative active warming versus standard passive warming positively impacted core temperature and the incidence of inadvertent perioperative hypothermia in parturients scheduled for elective repeat cesarean delivery
Data collection for baseline state of inadvertent perioperative hypothermia occurred between January and May 2017 and the active warming phase was instituted between June and October 2017
Summary
Inadvertent perioperative hypothermia in the general surgical population (core temperature < 36 °C) is associated with complications ranging from bleeding and cardiac dysfunction to increased infections [1,2,3]. Inadvertent perioperative hypothermia occurs in 60–90% during cesarean delivery as a result of peripheral vasodilation, diminished regulatory vasoconstriction, and reduced shivering responses that promote heat redistribution during neuraxial anesthesia [4,5,6,7,8]. This may result in decreases in neonatal temperature, umbilical blood pH, Apgar scores and associated adverse outcomes [6, 9,10,11]. The purpose of this retrospective observational cohort study was to determine if the addition of preoperative forced air warming in conjunction with intraoperative underbody forced air warming improved core temperature and reducing inadvertent perioperative hypothermia during elective repeat elective cesarean delivery with neuraxial anesthesia
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